Eizo Kayashima

Roles of alcohol consumption in fatty liver: A longitudinal study

BACKGROUND & AIMS Roles of alcohol consumption in non-alcoholic fatty liver disease are still controversial, although several cross-sectional studies have suggested the beneficial effect of light to moderate drinking on fatty liver. We analyzed the longitudinal relationship between drinking pattern and fatty liver. METHODS We included 5297 Japanese individuals (3773 men and 1524 women) who underwent a baseline study in 2003 and follow-up at least once from 2004 to 2006. Generalized estimating equation was used to estimate any association between drinking pattern and fatty liver assessed by ultrasonography. RESULTS At baseline, 1179 men (31.2%) and 235 women (15.4%) had fatty liver; 2802 men (74.2%) and 436 women (28.6%) reported alcohol consumption. At the latest follow-up, 348 of 2594 men (13.4%) and 101 of 1289 women (7.8%) had newly developed fatty liver; 285 of 1179 men (24.2%) and 70 of 235 women (29.8%) demonstrated a remission of fatty liver. In men, drinking 0.1-69.9 g/week (odds ratio, 0.79 [95% confidence interval, 0.68-0.90]), drinking 70.0-139.9 g/week (0.73 [0.63-0.84]), drinking 140.0-279.9 g/week (0.69 [0.60-0.79]), and drinking ⩾280.0 g/week (0.68 [0.58-0.79]) were inversely associated with fatty liver after adjusting for obesity, exercise, and smoking. In women, drinking 0.1-69.9 g/week (0.71 [0.52-0.96]) and drinking 70.0-139.9 g/week (0.67 [0.45-0.98]) were inversely associated with fatty liver after the adjustment. CONCLUSIONS Light to moderate alcohol consumption, or even somewhat excessive amounts especially in men, was likely to protect most individuals against fatty liver over time.

854 IMPACT OF ALCOHOL CONSUMPTION ON THE PRESENCE, DEVELOPMENT, AND IMPROVEMENT OF FATTY LIVER IN MEN AND WOMEN

854 IMPACT OF ALCOHOL CONSUMPTION ON THE PRESENCE, DEVELOPMENT, AND IMPROVEMENT OF FATTY LIVER IN MEN AND WOMEN A. Moriya, Y. Iwasaki, S. Ohguchi, E. Kayashima, T. Mitsumune, H. Taniguchi, F. Ikeda, K. Yamamoto. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Junpukai Health Maintenance Center, Okayama, Japan E-mail: moriyaakio@gmail.com

P1016 : Factors associated with the development of fatty liver or glucose intolerance

measuring different quantities and so bias cannot be assessed directly. The recently cleared (FDA, CE Mark, and TGA) HepaFatScan MRI method reports a volumetric fraction of liver tissue that is fat, a measure that can be directly compared with measurements from biopsy histological sections. This study measures the degree of bias of the HepaFat-Scan method against unbiased stereological measurements from biopsies. Stereological analysis (SA) is a method of obtaining unbiased estimates of volume fractions of a phase of material in a 3D matrix from a cross section through the matrix. Methods: Volumetric fractions of fat in liver tissue of 59 patients (autoimmune hepatitis 3, alcoholic liver disease 2, viral hepatitis 16, NAFLD 10, NASH 17, normal 3, primary sclerosing cholangitis 4, other 4) recruited from the hepatology outpatient clinics at Fremantle and Sir Charles Gairdner Hospitals (Western Australia) were measured by SA of digital images of histological sections of liver biopsies and with non-invasive HepaFat-Scan measurements. Bland–Altman (BA) statistics were used to assess the bias between the two methods of measurement. A steatosis grade for each biopsy was also assessed by an experienced hepatopathologist. ROC curve analysis was used to determine sensitivity and specificity of HepaFat-Scan for predicting steatosis grade. Results: Figure 1 shows a plot of the volumetric fraction of fat measured by HepaFat-Scan plotted against that measured by SA of biopsy histological sections. The straight line is the line of equivalence (not a fitted regression line). BA analysis indicates a small systematic bias with HepaFat-Scan reporting volumetric liver fat fractions 1.4% higher than SA of biopsy. Sensitivities, specificities and areas under ROC curve for HepaFat-Scan predicting steatosis grade >0 were 97%, 96%, and 0.963; >1 were 100%, 94%, and 0.996; and >2 were 100%, 88%, and 0.971. Conclusions: The 1.4% bias between HepaFat-Scan and SA of biopsy is not clinically significant since it represents less than 5% of the overall range of fat fractions measured. The observed high sensitivities and specificities indicate that overall accuracy of HepaFat-Scan is sufficient for clinical patient management.

Su1039 The Longitudinal Association Between Alcohol Consumption and Fatty Liver in Japanese Subjects

Background: Nonalcoholic steatohepatitis (NASH) is the hepatic manifestation of obesity and can progress to liver cirrhosis even during childhood and early adulthood. The aim of this study was to determine the frequency of NASH as an indication for liver transplantation (LT) in children and young adults and to characterize patient and graft survival in this cohort using a comprehensive large national liver transplantation registry in the U.S. Methods: The study included all children and young adult patients (up to the age of 40 years) who underwent LT in the U.S. from the 1987-2012 United Network for Organ Sharing and Organ Procurement and Transplantation Network (UNOS/OPTN) database. We created a modified NASH category that included LT recipients who were given a primary diagnosis of NASH plus obese patients with primary diagnosis of cryptogenic cirrhosis (CC). KaplanMeier analysis was used to assess patient and graft survival. Results: A total of 330 patients were included (111 with NASH and 219 with CC and BMI ≥ 30 kg/m2). 52% were male, 68% were Caucasian, the mean BMI was 33.6 ± 6.3 and diabetes was present in 18%. Age at time of LT ranged between 4 and 40 years with a mean of 33.9 ± 6.6 years. 14 subjects were < 18 years of age at time of LT and 20 were between the ages of 18-25 years. A progressive increase in NASH as the primary indication for LT in young subjects is seen from 2001 to 2012 (Figure). Median follow-up after 1st LT was 45.8 months [10.7, 97.3]. During this time 30% of subjects (n = 100) died and 11.5% (n = 38) were re-transplanted including 13 for NASH recurrence. Conclusion: NASH can progress to end-stage liver disease requiring LT in childhood and early adulthood. A significant number of young patients transplanted for NASH cirrhosis required re-transplantation with one third being done for NASH recurrence.

Roles of Alcohol Consumption and Body Mass Index in Fatty Liver in Japanese Men and Women

Background & Aims: Excessive alcohol consumption causes alcoholic fatty liver disease and excessive nutrition causes non-alcoholic fatty liver disease. However, a number of studies have reported an inverse association between moderate alcohol consumption and fatty liver; we have also described the inverse correlation between drinking frequency and prevalence of fatty liver. We aimed to determine the association among fatty liver, alcohol consumption, and nutrition, using body mass index (BMI) as a surrogate for nutrition. Methods: We obtained the clinical and laboratory data from 6,273 Japanese subjects who underwent ultrasonography as a part of systematic health checkups at Junpukai Health Maintenance Center in 2006, excluded individuals with concurrent liver disease and/or any missing components of data, and analyzed 4,158 men and 1,450 women (median age 49 year old). We stratified drinking frequency into 4 categories (non-drinker, drinking on 1-3 days/week, drinking on 4-6 days/week, and daily drinking) and BMI into 4 categories (<18.5 kg/m2 [underweight], 18.5-25 kg/m2 [normal range], 25-30 kg/m2 [overweight], and ≥30 kg/m2 [obese]) and performed logistic regression analysis and Cochran-Armitage test for trend. Results: In men, 32% had fatty liver; 73% reported habitual drinking (drinking at least once a week). The presence of fatty liver was inversely associated with habitual drinking (adjusted odds ratio, 0.71; 95% CI, 0.60-0.84). The prevalence of fatty liver in each BMI category was 0.63% (1/160) in underweight, 21% (590/2,802) in normal range, 60% (633/1,053) in overweight, and 78% (111/143) in obese subjects. The prevalence of fatty liver in each drinking frequency (non-drinker, drinking on 1-3 days/week, drinking 4-6 days/week, and daily drinking) was 0%, 0%, 0%, and 1.4% in underweight; 25%, 21%, 22%, and 18% in normal range; 65%, 63%, 60%, and 54% in overweight; 80%, 76%, 86%, and 70% in obese subjects, respectively. Trend toward an inverse association between drinking frequency and prevalence of fatty liver was observed in normal range (P < 0.001) and in overweight subjects (P = 0.003). In women, 14% had fatty liver; 31% reported habitual drinking. The presence of fatty liver was inversely associated with habitual drinking (odds ratio, 0.63; 95% CI, 0.45-0.89), but it was not significant after adjustment for other confounders. The prevalence of fatty liver in each BMI category was 0% (0/181) in underweight, 9.4% (100/1,065) in normal range, 48% (81/170) in overweight, and 82% (28/34) in obese subjects. No significant trend toward an association between drinking frequency and prevalence of fatty liver was observed in each BMI category. Conclusions: The frequency of alcohol consumption was inversely correlated to the prevalence of fatty liver in normal range and overweight men.